| Objective:To explore the combined application of whole-brain CT perfusion and neck CT angiography by 640-slice dynamic volume CT in non-lacunar pathogenesis in patients of lacunar infarction.Methods:The 192 patients with suspected acute lacunar infarction met the inclusion criteria were examined by the whole-brain perfusion CT imaging combined with the neck CT angiography with Toshiba 640-slice dynamic volume CT, within 24-hours brain diffusion-weighted imaging (DWI) was reviewed. Using the Volume Rendering (VR), Maximal Intensity Projection (MIP), Multiplanar Reformation (MPR) and other post-processing techniques to display the artery’s dimensional and evaluate atherosclerotic plaque and arterial stenosis case, all patients’bilateral carotid artery Common Carotid Arteries (CCA), Internal Carotid Artery, (ICA) and Vertebral Artery, (VA) were selected for the study. The non-parametric deconvolution algorithm (Singular Value Decomposition, SVD) is used to generate the perfusion parameters of Cerebral Blood Flow (CBF), Cerebral Blood Volume (CBV), Mean Transit Time (MTT) and Time to Peak (TTP) automatically. The cerebral artery territory was divided as the Anterior Cerebral Artery (ACA) supply area, the Middle Cerebral Artery (MCA) supply area, Posterior Cerebral Artery(PCA) supply area, ACA/MCA junction (Pre watershed area) and MCA/PCA junction (Posterior watershed area). According to an appropriate various sizes and shapes, the lacunar infarct lesion was manual laid out as ROI and the contralateral consistent same size area was as a mirror ROI. The each ROIs’ perfusion parameters values of CBF CBV MTT TTP were measured and record, then the ratio of each perfusion parameters of ROIs and mirrored ROIs was calculated. The cerebellum level, the basal ganglia level, the parietal lobe levels and the parietal levels were selected as typical levels, the size of about 100 pixels’manual ROI in each typical level were measured in the patients which were negative for CT perfusion and DWI. SPSS 22.0 software was used for statistical analysis, the independent sample t-test was used for the measurement data of normal distribution, the paired t-test was used for comparing the mirror measurement data, the R×C x2-test was used for the count data, the Spearman rank correlation coefficient described the correlation between rating count data. P<0.05 was considered statistically significance, P<0.01 was considered significant statistical significance.Results:(1) The LI-positive group was 139 cases (72.40%),96 cases of male,43 cases of female. the LI-negative group was 53 cases (27.60%),18 cases of male,35 cases of female. The incidence of male and female patients was statistically significant difference (x2=19.601, P=0.000<0.01). (2) 336 lacunar infarction lesions were found in 192 cases,45 (13.39%) cases of the ACA supply area lesions, 198(58.93%) cases of the MCA supply area lesions,16 (4.76%) cases of the PCA supply area lesions,53 (15.77%) cases of the ACA/MCA junction area lesions,24 (7.15%) cases of the MCA/PCA junction area lesions, the difference of LI lesion’s distribution and number in male and female groups both weren’t statistically significant (x2=4.477, P=0.345>0.05, x2=2.510, P=0.643>0.05). (3) According to the number of lesions,192 cases was devided as 53 cases of the negative group,56 cases of the unilateral single group,34 cases of the unilateral multiple group,11 cases of the bilateral single group and 38 cases of the bilateral multiple groups, the difference of lesions numbers in male and female groups was not statistically significant (x2=2.510, P=0.643>0.05). (4) The LI-positive group perfusion parameters of CBF CBV MTT TTP (x±s) were (50.39±14.51) ml·100g-1·min-1 (3.95±1.54)ml·100g-1 (2.56±0.78)S and (21.73±4.89)S respectively, the mirror ROI area perfusion parameters of CBF CBV MTT TTP (x±s) were (47.73±10.42)ml·100g-1·min-1 (3.31±0.76) ml·100g-1 (4.89±1.21)S (8.52±1.04)S, The LI-positive group’s MTT and TTP were prolonged, the difference of MTT was statistically significant (t=2.038, P=0.042<0.05), the difference of TTP was statistically significant significance (t=13.767, P=0.000<0.01). (5) The relative perfusion parameters of rCBF rCBV rMTT rTTP (x±s) of the LI-positive group were 0.83±0.34 0.91±0.23 1.38±0.27 1.47±0.19, the relative perfusion parameters of rCBF rCBV rMTT rTTP (x±s) of the LI-negative group were 1.07±0.211.04±0.15 0.99±0.18 0.92±0.22, the positive group rCBV is lower than the negative group, the difference was not statistically significant (t= 1.934, P=3.478>0.05), the LI-positive group’s rCBF reduced, rMTT and rTTP extended than the negative group, the differences were statistically significant (t=-3.273, P=0.002<0.01, t=2.218, P=0.000<0.01, t=2.657, P=0.000<0.01). (6) In the LI-negative group of 53 cases, there were 38 cases (66.40%) of the plaque-positive and 15 cases (33.96%) of the plaque-negative. In the single-LI lesions group of 90 cases, there were 62 cases (68.89%) of the plaque-positive and 28 cases (31.11%) of the plaque-negative. In the multiple-LI lesions group of 49 cases, there were 37 cases (75.51%) of the plaque-positive and 12 cases (24.49%) of the plaque-negative. The incidence in the LI-negative group, the single-LI lesions group and the multiple-LI lesions group were statistically significant difference (x2=29.881, P=0.000<0.01), but the incidence in the single-LI lesions group and the multiple-LI lesions group was no statistically difference (x2=0.679, P=0.410>0.05). (7) 684 plaques were found in total 1152 segments of the neck arteries in 192 subjects. In the LI-negative group of 90 cases, the distributions of plaque positions were carotid artery 34.44%(31/90), internal carotid artery 45.56%(41/90) and vertebral artery 20.00%(18/90). In the single-LI lesions group of 372 cases, the distributions of plaque positions were carotid artery 40.05%(149/372), internal carotid artery 44.09%(164/372) and vertebral artery 15.86%(59/372). In the multiple-LI lesions group of 22 cases, the distributions of plaque positions were carotid artery 30.19%(87/222), internal carotid artery 42.34%(94/222) and vertebral artery 18.47%(41/222). The plaque positions in the LI-negative group, the single-LI lesions group and the multiple-LI lesions group were no statistically difference (x2= 1.765, P=0.779>0.05). (8) 684 plaques were found in total 1152 segments of the neck arteries in 192 subjects. In the LI-negative group of 90 cases, the distributions of plaque natures were fatty plaque 13.33%(12/90), fibrous plaque 30.00%(27/90), calcified plaque 44.44%(40/90) and mixed plaque 12.22%(11/90). In the LI-positve group of 594 cases, the distributions of plaque natures were fatty plaque 21.55%(128/594), fibrous plaque 5.22%(31/594), calcified plaque 7.91%(47/594) and mixed plaque 65.32%(388/594). The plaque natures in the LI-negative group and the LI-positve group were statistically difference (x2=251.578, P=0.000<0.01). The difference between the fatty plaque group and the negative group was statistically significant (x2=28.988, P=0.000<0.0125, OR=5.574,5.457<95% CI <18.816), the difference between the mixed plaque group and the negative group was statistically significant (x2=227.856, P=0.000<0.0125, OR=33.509,17.917<95%CI <62.671). The difference between the fibrous plaque group and the negative group, the calcified plaque group and the negative group were both no statistically significant (X2=0.097 P=0.756>0.0125,x2=0.221 P=0.638>0.0125). (9) 684 stenoses were found in total 1152 segments of the neck arteries in 192 subjects,468 segments were non-stenosis. The distributions of stenoses in the LI-negative group were non-stenosis 71.70%(228/318), mild-stenosis 20.75%(66/318) moderate-stenosis 6.60%(21/318), severe-stenosis 0.94%(3/318). The distributions of stenoses in the single-LI lesions group were non-stenosis 31.11%(168/540) mild-stenosis 50.19%(271/540) moderate-stenosis 14.81%(80/540), severe-stenosis 3.89%(21/540).The distributions of stenoses in the multiple-LI lesions group were non-stenosis 24.49%(72/294), mild stenosis 56.46%(166/294), moderate stenosis 14.63%(43/294), severe stenosis 4.08%(12/294), closing group 0.34%(1/294), The number of LI lesions and arterial stenosis’ Spearman’s rank correlation coefficient=0.325, P=0.000<0.01.Conclusion:(1) The incidence of acute lacunar infarction in male was higher than female, but the location and number of infarcts had no difference in sex. (2) Compared with the contralateral hemisphere’mirror area, the acute lacunar infarct areas’ CBF and CBV had no significant changes, however, the MTT and TTP were extended and the TTP changed significantly. Besides, Infarct areas’ rCBV had no significant changes, the rCBF were reduced, the rMTT and rTTP were prolonged significantly. (3) The incidence of neck atherosclerosis in the acute lacunar infarction was higher than the non-acute lacunar infarction, but there was no correlation between the incidence and the number of infarcts.The fatty plaque and mixed plaque were both strong exposure factors, but there was no correlation between the location of plaques and the acute lacunar infarction. (4) The numbers of acute lacunar infarction had a weak positive correlation with the degree of stenosis caused by neck atherosclerosis. |
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